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Dean Barbara Hazard

in her own words - spring/summer 2008

In 1991, Barbara Hazard arrived as dean of the Boston College School of Nursing. Hazard was both an established scholar in the nursing community, and a strong cultural fit for this Jesuit institution with a rising reputation. As she prepares to retire after 16 years of service to Boston College and the Connell School of Nursing, we offer her reflections on her tenure as dean, in her own words.

Coming to BCBefore coming to BC, I had never applied for a position as dean of anything. I had not aspired to be a dean, but the letter [asking if I was interested] came in the mail. At the time, I was the assistant director for nursing research at the University of Pennsylvania, and was living between Philadelphia and Connecticut. I liked BC. My daughter Stephanie had gone here. I had thought highly of the place for years, and always thought it might be a good fit. I decided to go ahead and agreed to put my materials forward, to put my hat in the ring. I was serious enough to come and take a look at it, but I certainly wasn’t convinced I wanted to be a dean.

Because I had the good fortune to have worked with some deans that I looked up to, I had it in my head the things I liked about what they did or what they didn’t do. For example, Claire Fagin at Penn—everyone looked up to Claire Fagin. She was really an entrepreneur. I didn’t try to emulate her behaviors or anything like that, but there were things I learned from her, about marketing, in particular. If anybody was doing anything at Penn, she made sure the [university community] knew about it. She had an incredible ability to attract really good faculty to work with her. So when I got to BC, what I thought I wanted to do was really strengthen up the research and strengthen up the faculty. BC has come up in everybody’s ratings and has become a national player. Along with the additional visibility, that brings more top-level students and faculty.

What’s in a Name: Becoming the William. F. Connell School of NursingThe biggest thing that’s happened during my time as Dean has been the naming of the nursing school for the late William F. Connell. Becoming a named school is an important and exciting milestone for any institution, but to be connected with Bill Connell was especially meaningful. First, because Bill was so highly regarded in this city, his name will always generate goodwill for our school. Second, it’s a wonderful tribute because of the personal ties. Bill was a BC alumnus and member of the BC Board of Trustees. His daughter Lisa is a Connell School alumna. One of BC’s trustees pulled me aside at one point and commented “nobody will ever mess with the school with Bill Connell’s name on it.”

The naming also brought us other benefits. It certainly brought financial support. But more importantly it brought a prestige to the school. There’s a sense that schools don’t get named unless they are important. At the national level, people perk up. Within the University people seem to say it with pride and use it. That’s a big deal.

The Changing Needs of the Nursing ProfessionThe major curriculum changes that we’ve made in the School of Nursing have been at the master’s level. The Ph.D. program has changed some; we’ve added some additional courses in quantitative methods. The undergraduate program develops as clinical practice changes, but structurally hasn’t changed a great deal. The masters program has shifted largely because of market forces. I think that’s where the biggest changes occurred.

When I first got here, we were educating nurse practitioners and clinical nurse specialists, and we were educating a lot of clinical nurse specialists. Shortly after I arrived, an overwhelming number of clinical nurse specialists got laid off in the hospitals. I think 30 got laid off in one week at one institution. It was at the time when hospitals were really trying to save money, and did so by cutting out the middle manager. Consequently, people stopped coming to school to be clinical nurse specialists. There was a great need for nurse practitioners at that point, so we had to really ramp up, improve our offerings, which first meant helping some faculty become NP’s so they could teach the curriculum. It meant we had to hire faculty to teach in those areas where we didn’t have NP’s.

This shift happened across the country. We weren’t driving it. At the time, I had some clinical nurse specialists say to me, “You people in academia, you just stopped running your clinical nurse specialist programs. You all wanted us to be nurse practitioners”. In reality, we just reacted to the market. We couldn’t continue to run a program without any students. We had to meet the needs of the public.

Very recently, hospitals have started to again appreciate the need for the clinical nurse specialist role, although in a somewhat different model than existed before. We are facing the challenge of how to respond to this new model.

Master’s Entry: A Non-Traditional Pathway to Advanced Practice NursingOne significant change was the introduction of the master’s entry option here at BC, which allows non-nurses to pursue a master’s degree in nursing. I saw [this idea] work at Yale when I was on the faculty there, and then at the MGH Institute here in Boston. The idea of taking non-nurses and in two years turning out an advanced practice nurse was not something that everyone agreed with; initially, some people were very upset by this idea. But at Yale I had seen these incredibly bright people who had degrees in other fields coming into nursing, which made me very happy. I did a study there along with Judy Kraus, who later became the dean at Yale. We looked at theory and clinical performance, and there was simply no difference after the first semester. Master’s entry students did just as well in the clinical courses as people who had been nurses for 10 or 20 years. When the accreditors came through, they asked me if I did things differently based on where the students came from at Yale. I had to tell them, “I don’t always know which is which to be honest with you.”

At first, the faculty didn’t warm up to the master’s entry concept, but Loretta Higgins—who was the associate dean at the time—began to get many inquiries. This was at a time when many nurses weren’t returning to school for their master’s. We had a real need to boost our student numbers, and master’s entry was the obvious way to do this. I’m thrilled we did, because our master’s entry students today are very bright, capable people. In many ways I wish we could take in more because they are so bright and the need for good nurses is so great, but we can only take what the faculty and our clinical placements can manage.

Master’s entry was a big shift in thinking for BC. While some faculty didn’t think it was a great idea to begin with, nobody ever tried to sabotage or put it down in any way. Maybe some faculty didn’t think we should have the program, but even the most adamant critics were terrific teachers for those students when they got here. That’s one of the wonderful things about the culture here at the Connell School.

Creating a Nurse Anesthesia SpecialtyIf someone asks to talk to me, I will always say yes. So when Laurel Eisenhauer and I were approached by Sue Emery to see if the Connell School was interested in being the home for a nurse anesthesia program, Laurel said to me, “We’ll never start a nurse anesthesia program” and I said, “No, I can’t see us doing that because we’re not part of an academic medical center. I don’t see how it could work, but you know she’s a colleague and we can give her an hour of our time.”

When we saw that Anaesthesia Associates of Massachusetts had been providing clinical placements for nurse anesthesia students and knew how to do that well, we began to understand how a partnership might be possible. Because of their affiliations with a number of hospitals in the area, our students would have access to a range of clinical settings.

Not all nurses think that anesthesia is a great role for nurses. But nurses have been giving anesthesia for a long time; the first person other than physicians and medical students to give anesthesia was a nurse. Today, nurses provide about sixty percent of the anesthesia in this country. Anesthesia is conceptually not that different from other nursing roles: You assess the client, you manage them, you monitor them, you administer medications, you monitor the outcomes, and you deal with the patient. Anesthesia is a highly sophisticated nursing role, but I think it fits right into the nursing model. There was a time in our history when it was thought that nurses shouldn’t take blood pressures. Some doctors thought nurses shouldn’t do it, and some nurses thought they shouldn’t do it because it involves medical technology. But technology is just a tool. It’s the core of the nursing that matters, not the particular tool in our hands. I am supportive of nurses doing what they’re prepared to do and well qualified to do.

Nationally, there’s a huge need for nurse anesthetists. We could see the advantage of providing these nurse anesthetists with both the solid advanced practice nursing foundation, and strong clinical experience in their specialty. It has worked out terrifically. The students have been welcomed here. They have done very well in all the coursework, including the core that all master’s students take. If I had been rude and unwilling to listen to Sue Emery—now the director of the nurse anesthesia program—this program and partnership may never have existed.

The Future of NursingThere are a number of challenges in the nursing profession that BC and other nursing schools will need to respond to in the near future. One big thing that’s going on right now at the national level is the DNP—the Doctor of Nursing Practice. This new degree presents both challenges and opportunities for BC and all nursing schools. It raises questions about the role of the master’s degree in nursing, and questions about building and maintaining a reasonable pipeline of PhD-prepared nurses.

Developing Ph.D.-prepared nurses who can fill faculty roles is a major challenge now and one that will continue. Nationally, there is already a severe faculty shortage, and with the aging of the faculty, this will likely continue. It’s not hard to understand why we have a shortage of Ph.D.-prepared nurses. Nursing is a stable, satisfying career at all levels of practice; given the opportunities available at all levels from associate degree-prepared nurses on up, some nurses don’t see the value in taking on student debt and taking a break from work to achieve higher levels of education.

Yet there are advantages to additional education in nursing. At the master’s level, nurses have the opportunity to become more autonomous, independent practitioners. At the doctoral level, nurses have the opportunity to contribute to nursing science and research. Part of the solution is proving to employers the value of the bachelor’s-prepared nurse as the entry level for practice. This would encourage more nurses to begin to consider additional education.

Also, nursing schools need to find the resources to help more students finance their education through scholarships and other mechanisms. We need to provide more convenient schedules and distance learning opportunities using the Internet and cutting-edge technology. Nursing is in many ways a very practical profession, and we need to address the challenges we face with practical solutions that will make sense to nurses in the field.

Continuing to Teach While DeanAt all of the schools I was at before, the deans taught. I think it’s important that deans and other administrators continue to teach. It keeps you grounded, up to date in your area. It makes you continue to appreciate the work faculty do. Up until this year, I taught my statistics course once a year for the doctoral students. I only teach about ten students; let’s put that in perspective with what other people are doing. I don’t have to learn new meds or new treatments, I’m not taking students into a clinical area, and I’m not teaching 100 students. Still, I put in at least a solid day a week or more when I’m teaching, just to make sure I have solid, relevant examples. It’s a very time consuming proposition but really keeps you grounded. In all cases, deans come into their role with some kind of expertise and it would be a waste not to tap it.

Also, my love of statistics and research methodology has impacted my perspective as dean. My mindset is more on the scientific, mathematical side of things. Also, I was a pysch nurse in my past and that didn’t hurt at all being a dean!

On Leaving BCOne of the undergraduate students asked me what I would miss the most about BC, and I said my season tickets to football and basketball. I’ve always enjoyed sports. Athletics are a significant part BC’s identity, which for me has been a good fit because I love it. I’m a fan. At the same time, I’m also going to miss the shows at the Robsham Theater, and the openings at the McMullen Museum. All of these aspects of BC contribute to the culture here.

Still, next fall I am going to go to Italy with my sister come next fall instead of coming back to school. I have a two-week trip planned. Then I’m going to Japan to teach my statistics course. I’ve joined the board of trustees at Wheeling Jesuit University. I’ve been watching my friends who are retired and they’re all busy, but in a nice way. I plan to volunteer, perhaps at a local school or hospital. There’s the University of Rhode Island—of which I am a graduate—close by my home. There are plenty of opportunities for me to continue using my expertise. I’m returning home to where I grew up. That’s good for me.